Provider Demographics
NPI:1508998451
Name:HOLLIMON, TAMIKO (HOME HEALTH CARE)
Entity Type:Individual
Prefix:
First Name:TAMIKO
Middle Name:
Last Name:HOLLIMON
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 BRECKTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8138
Mailing Address - Country:US
Mailing Address - Phone:614-975-6046
Mailing Address - Fax:
Practice Address - Street 1:1570 HANSEN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-6202
Practice Address - Country:US
Practice Address - Phone:614-571-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2241658374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2241658Medicaid